Healthcare Provider Details

I. General information

NPI: 1316864259
Provider Name (Legal Business Name): MIND ON DEMAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11388 US HIGHWAY 501
MAXTON NC
28364-7678
US

IV. Provider business mailing address

11388 US HIGHWAY 501
MAXTON NC
28364-7678
US

V. Phone/Fax

Practice location:
  • Phone: 910-610-9127
  • Fax:
Mailing address:
  • Phone: 910-610-9127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT SHAWN PHILLIPS JR.
Title or Position: OWNER
Credential:
Phone: 910-610-9127